The Affordable Care Act was a groundbreaking moment in regards to healthcare legislation reform. Its goal was to decrease overall healthcare expenditures as an insurance mandate required more people to be paying premiums, which helped offset the healthcare costs of the sicker population. In addition, middle class families were provided subsidies to purchase higher quality insurance. Those who chose not to purchase insurance were given a tax penalty, however this was repealed in 2019. Another important factor of the ACA was the creation of an insurance exchange; an online market allowing consumers to compare and purchase health insurance plans. 

            Since the ACA was passed, the healthcare landscape has changed significantly. A larger emphasis is now placed on quality and preventative care. While some of the regulations within the ACA are no longer in place, many states have taken note of the increased emphasis on primary/preventative care and made that a point of emphasis within their own healthcare plans. Several states have passed legislation, or are working towards legislation that reallocates healthcare spending to primary care, with the intention of providing higher quality care.